Symptom clusters and core symptoms in early postoperative esophageal cancer patients

Purpose Patients undergoing esophagectomy frequently experience diverse and complex symptoms. This study aimed to identify clusters of early postoperative symptoms and determine core symptoms among these patients, to facilitate targeted symptom management strategies. Methods This prospective cohort study included 361 patients who underwent esophageal cancer surgery at a tertiary Grade A hospital in Harbin between 2023 and 2024. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (QLQ-C30) and the Esophageal Cancer-Specific Module (QLQ-OES18) were used to assess 18 symptoms one month postoperatively. Exploratory factor analysis and network analysis were conducted to identify symptom clusters and core symptoms, respectively. A 1-month landmark survival analysis was performed to examine their associations with 1-year postoperative survival, using a parsimonious multivariable Cox regression model. Results Five distinct symptom clusters were identified: eating-related (eating difficulty, reflux, choking, appetite loss, nausea, vomiting, dysphagia; prevalence 49.0%), breathing-related (cough, dyspnea, insomnia; prevalence 47.0%), pain-related (esophageal pain, generalized pain; prevalence 48.0%), fatigue-speech related (fatigue, dry mouth, trouble talking; prevalence 51.0%), and excretion-related (constipation, diarrhea; prevalence 50.0%). Network analysis identified fatigue (relative strength [rS] = 2.83), pain (rS = 1.69), and insomnia (rS = 1.58) as core symptoms, with fatigue serving as the key bridge symptom. In the 1-month landmark analysis, no statistically significant association was detected between symptom clusters or core symptoms and 1-year postoperative survival. Conclusion This study identified distinct symptom clusters and core symptoms one month post-esophagectomy that merit clinical attention during postoperative follow-up. Specifically, fatigue represents a key therapeutic target for developing intervention strategies.